SOP 104.58-att-6: Alcohol and Drug Test Notification (Random)
Summary
Key Topics
- random drug testing
- alcohol testing
- drug test notification
- employee testing
- refusal to test
- specimen collection
- drug screening
- employee dismissal
- state employment disqualification
- custody and control form
Full Text
SOP 104.58
Attachment 6
8/19/20
MEMORANDUM
TO: Employee Name and SSN
FROM: Appointing Authority Name/Title
SUBJECT: ALCOHOL and/or DRUG TEST NOTIFICATION (RANDOM)
DATE: Date Being Issued
Your position has been randomly selected for drug testing. You will:
1. Report to the designated testing location
2. Bring a picture ID
3. Receive the Custody and Control Form; and
4. A copy will be provided to you
You are advised that if:
a) you expressly decline to submit to alcohol or other drug testing;
b) you fail to appear at the testing location by the specified time;
c) you engage in conduct that clearly obstructs the testing process;
d) you fail to provide adequate urine for testing (45ml.) and/or breath for alcohol testing
without an acceptable medical reason;
e) you leave the testing site before providing an adequate sample in the allotted time (up to 3
hours if necessary);
f) the temperature of your specimen is outside the acceptable range;
g) the laboratory and/or the MRO determine that your sample has been adulterated or
substituted, or,
h) the testing indicates use of an illegal drug(s) without a legitimate medical explanation.
This will be considered a Refusal and the actions described below will be taken:
You will be dismissed from employment and disqualified from state employment for a
period of 2 years from the date of notification.
I certify that I have read and understand the information contained in this document.
~~Applicant Signature~~ ~~Date/Time~~
Retention Schedule: Upon completion this form shall be retained permanently in the employee’s official and local personnel
file. If not hired, retain in the Interview/Selection file for two (2) calendar years.